Medische beeldvorming en stralingstherapie: recente ontwikkelingen en toekomstverwachtingen geillustreerd aan de hand van voorbeelden uit de kankerbestrijding
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TitleMedische beeldvorming en stralingstherapie: recente ontwikkelingen en toekomstverwachtingen geillustreerd aan de hand van voorbeelden uit de kankerbestrijding
Translated TitleMedical imaging and radiation therapy: recent developments and expectations illustrated with cancer cases
PubliekssamenvattingDe stand van zaken en toekomstige ontwikkelingen op het gebied van de toepassing van straling voor het diagnosticeren en behandelen van enkele frequent voorkomende vormen van kanker worden in dit rapport behandeld. Het is onderdeel van de Volksgezondheid Toekomst Verkenning 2002 van het Rijksinstituut voor Volksgezondheid en Milieu. Een scala aan moderne diagnostische beeldvormende technieken zoals dynamische MRI en computer tomografie maken zowel het identificeren en behandelen van tumoren als het evalueren van het behandelresultaat eenvoudiger. Drijvende kracht achter vele verbeteringen zijn de ontwikkelingen in de micro-elektronica en in de informatie- en communicatietechnologie. Informatie over de structuur van een aandoening wordt steeds vaker aangevuld met beelden die functionele aspecten belichten. Echter, eenvoudige technieken voor de vroegtijdige opsporing van tal van vormen van kanker zijn nog niet beschikbaar. Radiotherapie blijft, ook dit decennium, de belangrijkste op straling gebaseerde vorm van behandeling van kanker. Door optimaal inzetten van de nu reeds bekende inzichten op dit gebied is nog de nodige gezondheidswinst te boeken. De toekomst van bijvoorbeeld radio-immunotherapie en fotodynamische therapie blijft voorlopig onzeker. Het steeds vaker uitvoeren van kosten-baten analyses moet de kans op introductie van ineffectieve nieuwe diagnostische technieken verkleinen, ook bij de kankerbestrijding. Daarnaast zal de groeiende aandacht voor het bepalen van de kwalititeit van leven resulteren in een verbeterde evaluatie van behandelopties.
Discussed here is the state of the art and future developments of radiation application for diagnosing and treating several frequently occurring cancers. This report constitutes part of the Public Health Status and Forecast 2002, produced by the National Institute for Public Health and the Environment in the Netherlands. A variety of modern diagnostic imaging techniques such as dynamic MRI and computed tomography actually facilitate identification and treatment of tumours, along with the follow-up after treatment. The driving force behind this flourishing development is formed by the advancements in microelectronics and ICT. Information on the morphology of these disorders is being increasingly supplemented with visualized functional aspects. For most tumours simple screening techniques are, however, lacking. The dominant radiation-based cancer-treatment modality for this decade is still radiotherapy. Full exploitation of current radiotherapeutic know-how may clearly enhance cure rates. The future of such treatment modalities as radioimmunotherapy and photodynamic therapy remains uncertain. Increased implementation of cost-effectiveness analyses must reduce the risk of introducing ineffective new diagnostic techniques and treating cancer. Growing interest in quality-of-life assessments will improve the evaluation of alternative treatment modalities.
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Lifetime and baseline alcohol intakes and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition study.Naudin, Sabine; Li, Kuanrong; Jaouen, Tristan; Assi, Nada; Kyrø, Cecilie; Tjønneland, Anne; Overvad, Kim; Boutron-Ruault, Marie-Christine; Rebours, Vinciane; Védié, Anne-Laure; et al. (2018-03-09)Recent evidence suggested a weak relationship between alcohol consumption and pancreatic cancer (PC) risk. In this study, the association between lifetime and baseline alcohol intakes and the risk of PC was evaluated, including the type of alcoholic beverages and potential interaction with smoking. Within the European Prospective Investigation into Cancer and Nutrition (EPIC) study, 1,283 incident PC (57% women) were diagnosed from 476,106 cancer-free participants, followed up for 14 years. Amounts of lifetime and baseline alcohol were estimated through lifestyle and dietary questionnaires, respectively. Cox proportional hazard models with age as primary time variable were used to estimate PC hazard ratios (HR) and their 95% confidence interval (CI). Alcohol intake was positively associated with PC risk in men. Associations were mainly driven by extreme alcohol levels, with HRs comparing heavy drinkers (>60 g/day) to the reference category (0.1-4.9 g/day) equal to 1.77 (95% CI: 1.06, 2.95) and 1.63 (95% CI: 1.16, 2.29) for lifetime and baseline alcohol, respectively. Baseline alcohol intakes from beer (>40 g/day) and spirits/liquors (>10 g/day) showed HRs equal to 1.58 (95% CI: 1.07, 2.34) and 1.41 (95% CI: 1.03, 1.94), respectively, compared to the reference category (0.1-2.9 g/day). In women, HR estimates did not reach statistically significance. The alcohol and PC risk association was not modified by smoking status. Findings from a large prospective study suggest that baseline and lifetime alcohol intakes were positively associated with PC risk, with more apparent risk estimates for beer and spirits/liquors than wine intake. This article is protected by copyright. All rights reserved.
Which cancer survivors are at risk for a physically inactive and sedentary lifestyle? Results from pooled accelerometer data of 1447 cancer survivors.Sweegers, M G; Boyle, T; Vallance, J K; Chinapaw, M J; Brug, J; Aaronson, N K; D'Silva, A; Kampshoff, C S; Lynch, B M; Nollet, F; et al. (2019-08-16)
Dietary intake of different types and characteristics of processed meat which might be associated with cancer risk--results from the 24-hour diet recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC).Linseisen, Jakob; Rohrmann, Sabine; Norat, Teresa; González, Carlos Alberto; Dorronsoro Iraeta, Miren; Morote Gómez, Patrocinio; Chirlaque, María-Dolores; Pozo, Basilio G; Ardanaz, Eva; Mattisson, Irene; et al. (2006-06-01)OBJECTIVE: There is increasing evidence for a significant effect of processed meat (PM) intake on cancer risk. However, refined knowledge on how components of this heterogeneous food group are associated with cancer risk is still missing. Here, actual data on the intake of PM subcategories is given; within a food-based approach we considered preservation methods, cooking methods and nutrient content for stratification, in order to address most of the aetiologically relevant hypotheses. DESIGN AND SETTING: Standardised computerised 24-hour diet recall interviews were collected within the framework of the European Prospective Investigation into Cancer and Nutrition (EPIC), a prospective cohort study in 27 centres across 10 European countries. SUBJECTS: Subjects were 22,924 women and 13,031 men aged 35-74 years. RESULTS: Except for the so-called 'health-conscious' cohort in the UK, energy-adjusted total PM intake ranged between 11.1 and 47.9 g day(-1) in women and 18.8 and 88.5 g day(-1) in men. Ham, salami-type sausages and heated sausages contributed most to the overall PM intake. The intake of cured (addition of nitrate/nitrite) PM was highest in the German, Dutch and northern European EPIC centres, with up to 68.8 g day(-1) in men. The same was true for smoked PM (up to 51.8 g day(-1)). However, due to the different manufacturing practice, the highest average intake of NaNO2 through PM consumption was found for the Spanish centres (5.4 mg day(-1) in men) as compared with German and British centres. Spanish centres also showed the highest intake of NaCl-rich types of PM; most cholesterol- and iron-rich PM was consumed in central and northern European centres. Possibly hazardous cooking methods were more often used for PM preparation in central and northern European centres. CONCLUSIONS: We applied a food-based categorisation of PM that addresses aetiologically relevant mechanisms for cancer development and found distinct differences in dietary intake of these categories of PM across European cohorts. This predisposes EPIC to further investigate the role of PM in cancer aetiology.